Hello everyone. Nice to have you here for our session. Today's session is what do you want to be when you grow up? Novel career development strategies from residency to practice. We hope that you will enjoy this session today. To pose questions to any of the faculty, please type questions in the Q&A or the chat field on the left side of your screen. Also regarding CME credit, as a reminder, you can earn CME for attendance in this session today, and your participation has been recorded. Due to high volume, it may take up to 48 hours for all data to be transferred to your Academy online accounts. For those attending the assembly in real time, the Academy recommends claiming your CME beginning Wednesday morning to ensure all of your participation has been accurately transferred. With that, I want to present our session. Our session, as I said, is what do you want to be when you grow up? Novel career development strategies from residency to practice. The objectives today are essentially as such. The reason that we set up this session is that career development and thinking about the job hunt can often start early in residency, or fellowship, or even sometimes in medical school in certain people, and strategizing a successful career development plan to get the job of your choice can be challenging without often local mentorship or guidance. The goal of this session is really to provide you, the trainee or early faculty novel strategies to go from, novel strategies to get to that faculty position. Today's presenters are faculty who we believe have successfully traversed the job hunt and have gone on to faculty positions in varied backgrounds. All faculty are relatively junior, so we're all within five to six years of completing residency, and we've all taken very different career paths that began being developed early in residency. We'll discuss pearls and what successfully got us to this point from residency, including career development plans, skills acquisitions, and networking, and challenges that we face along the way, including developing families, changing career plans, negotiations, and other things. The faculty expertise will focus on a physiatrist who started his own musculoskeletal practice, a physiatrist who started her own inpatient directorship within a non-academic hospital in a new state, and a physiatrist who's continuing a career as clinician scientist at an academic institution. We'll be talking about the following objectives, such as developing career strategies, listing strategies and opportunities that can help you develop the career that you want, and transition to finding a job. We'll be outlining barriers to successful career development, and also understand novel perspectives for finding a job from faculty with varying perspectives. Finally, I am very fortunate to have some wonderful co-faculty. Oh, excuse me, some wonderful co-faculty. So I'm Prakash J Balan. I am the Director of Clinical Musculoskeletal Research at the Shirley Ryan Ability Lab in Chicago, Illinois, and Assistant Professor in the Northwestern Feinberg School of Medicine. Justin Berthold is the founder of the Rehabilitation Physicians of Pittsburgh, an outpatient musculoskeletal practice in Pittsburgh. And Dr. Tracy Falcone, who will be our first speaker, is the Medical Director of Owensboro Health Regional Rehabilitation in Owensboro, Kentucky, and she'll be our first speaker today. And with that, I'll pass on to Tracy. Hi, good afternoon. It's great to be on here. And I'll start, no disclosures, with a little bit of background about who I am. So the meat and potatoes is kind of listed there, but just a background about myself. I was born and raised in rural Kentucky to a proudly blue-collar family, no real doctors in the family, or I didn't really even have a direct relationship with any physicians, but I knew I was strongly intrigued by the human body and anatomy, and that being a physician sounded wildly intriguing. So fortunately, I got a softball scholarship and played four years of softball at a local small university. I attended medical school at Lake Erie College of Osteopathic Medicine in Florida. And I began having an interest in physical medicine and rehabilitation. And about my third year, I was able to rotate with PM&R, and I just really found a liking to the variability of patients that you see and the impact that you can have on their lives. And so during that time, I met my future husband, who was currently a general surgery resident in the University of Pittsburgh program. So I was fortunate to match at that program as well and move my career forward with a great interest in musculoskeletal medicine, potentially sports and spine. But over the course of time, I've just broadened my interest into general physiatry. My career path led me back to Kentucky, to Owensboro to be close to family. Over the course of residency, I had two children, one at the end of my second year of residency, and then our daughter Gianna. And then our son, JD, was born mid-year of my fourth year. And so we had two children, two physicians, finishing residency at the same time and looking for careers. And our best career choice was in Kentucky, close to my family. And I started there as the very first physiatrist, running a 20-bed rehab unit and opening an outpatient practice. So there was a lot of novelty to that and a lot of trial and error, but we're happy and loving our career so far. So career development strategy. I've recently read a book called The Four Agreements by Don Miguel Ruiz, which is a non-spiritual book, but it kind of is a code of conduct that came from ancient Toltec wisdom. And I think a lot of this applies to our paths through our careers and just our interactions with other people that can greatly influence our paths in life. I believe my influence and my career choice greatly came from my mentors, but then also my family, who I had to kind of give an equal weight in helping me to find a direction. The first is be impeccable with your word. Number one, be responsible for what we say, but then also to really choose our words wisely in terms of how we present ourselves. Don't make assumptions. Always use those intriguing questions to clarify situations, to make sure that both sides of the party are on the same page. Three, don't take anything personally. I think this goes great with any feedback that we receive in residency and or our careers, just to be able to set back and evaluate situations in a non-judgmental way. And fourthly, do your best. If in each circumstance, whether it's medical school or a residency or your career path, if you just do your best, there's no regrets at the end of the day. So medical school, as I'd said, I'd chosen physical medicine and rehabilitation at the end of my third year, which gave me a whole fourth year to select my electives to be more focused towards other fields that could build upon my knowledge in physical medicine and rehab. So those include orthopedic surgery, radiology, and even rotating with DOs that had OMT focus. Within their outpatient practice, whenever I did choose PM&R rotations, I tried to choose institutions that I was interested in potentially having a residency career in, but also I really looked towards those mentors. I rotated at UPMC Mercy with, who was then their Dr. Goldberg, and he was in the traumatic brain injury unit. And he really had an impact on how to view patients in regards to progressing them towards self-actualization and actually returning responsibility to the patient for their overall recovery and rehab. During that time, really working up a good personal statement because I felt like that was a very foundational way that I conversed during my residency interviews. So some of my faculty mentors, whenever we had moved to University of Pittsburgh, Dr. Soa, who was then research and clinical faculty, and Dr. Gary Chimes, they were both integral in my MSK interest and also advised me in scholarly projects, getting into different research, which I really had no experience with in the past. And I felt like they were really able to foster those experiences, which I think are vital to the residency program, even if ultimately I'm not doing that in my current practice. I'm glad that I was able to see it, to have that experience, and to ultimately be able to choose. Dr. Gary Galang was a mentor, mostly on the inpatient realm. And he was kind of the one that put the bug in my ear, you know, like, don't give up on inpatient as a practice, like, you know, really consider, you know, your skill set and how you might be able to excel in certain things like that. And I was able to have structured mentor conversations with Dr. Chimes as well, who also kind of laid it out and helped me to establish a priority, if you will, of the direction. So this is happening around third year residency, I believe, trying to really hone in on where careers going just in case fellowship was going to be the next step. So some of my scholarly projects are here. And of course, they are MSK focused, but also I'm interested in nutrition, and I was able to do some nutritionally focused activities, specifically with Dr. Sowa as well. Other opportunities to think about in residency. So investing in each one of those rotations, regardless of interest, even in my practice, every single day, I think of, you know, how did, you know, my mentor in the spinal cord injury unit manage this patient or, you know, what kind of spasticity regimen would Dr. Moonen have used for cervical dystonia? So there's so many times that you really kind of think back on those, continue to use those four arguments, ask questions, don't assume that as you move up, that there's nothing left to learn, or that you should be experienced and proficient in all things. That's why we're in residency is to use those situations to ask questions and learn and proficient in all things. That's why we're in residency is to use those situations to ask questions and learn and really build off those mentorships. I did, I was able to kind of create an administrative elective during my fourth year, because I knew I was going to be medical director and then able to plug in and get extra rotations with EMG and ultrasound just to maintain a very broad residency experience to pull forward. Some challenge, I call them challenges rather than barriers. You know, having two children during residency, and then we had a third child at the end of my first year as a career attending Rosemary. I'd say they were challenges, blessings, all the same. They kind of having a larger family, having a general surgeon as a husband, initially having a path that was a little bit too singularly goal-focused, MSK, I think had been a barrier. And we did have a concentrated geographic preference when looking for a facility, and there were somewhat of a lack of mentors working currently in a more individually-based practice or private practice or even hospital-based community practice. And also, ultimately in my career, I ended up at a location that had no prior physiatrists there. The rehab unit was over 20 years old, but had been run by an internist, a neurologist, and I believe some rheumatology group at some point. There were also concerns as being a solo provider and maintaining call. So the approach to the career, obviously, John and I, my husband, John, really talked about our goals in regards to our family, our careers, and what we were and weren't able to do once the workday was done. That really led me to the hospital-based employed paradigm. I didn't feel like a business management plan was in my skill set. I didn't really feel like mentoring research projects and scholarly projects were in my skill set, but I really love and enjoy working as a team, administrating over the team, and just being with patients and seeing them to their fullest. Fortunately, my husband was able to get into the same hospital group in their general surgery and trauma program. He has a master's in medical education, and they were initiating a collaborative agreement with the University of Louisville where fourth-year surgical residents come in to do a community rotation. So he was really able to take that and run with it. So it was perfect for his career planning. He also does elective, he sets up electives for the medical students from Pikeville Osteopathic Medical School, and I have medical students from Pikeville, so I still get to teach. General physiatry just seemed to keep me interested. It met all, it ticked all the boxes in regards to what my interests were, but also what I needed for my family in terms of hospital-based things, a guaranteed salary. I didn't have to worry about the insurance plans of my patients, and I can just think about the medicine, just think about the team path, and I felt really comfortable with that. Here's the career path that we've had so far. I started out as sort of a 60% inpatient, 40% outpatient, but my role has evolved to be 100% inpatient with a developing consult service. As we had seen, the biggest demand for my need was in the inpatient rehab unit. The graph below, it's hard to read, but it just shows that since I've been, I've actually been there seven years, but since my initial employment, we've grown the rehab unit $7 million from their basic net profit, so I'm really able to see a substantial improvement with physiatry, and our outcomes are just getting a lot better in regards to now our GG code improvements over the length of a patient stay and patient satisfaction scores. Since I've been there, I've been able to add a nurse practitioner to the PM&R service line, and just this year, we added a Dr. Porter, who's a newly graduated resident as a second physiatrist who has a greater focus in the outpatient realm with electrodiagnostics and general outpatient physiatry as well, so definitely something to be proud of. And here we are, a lot of bulleted things, but just note, when on the job search, sometimes those job listings aren't going to tick every box, but think about where your skill set lies, different things that you feel like you could bring to the table. Coming into a position that a physiatrist hadn't been, it took a lot of education on my part to our management and administration, but ultimately, it was worth it to see the fruits of our labor and continue to utilize those mentors, continue to think back and look back on all those experiences, and while you're in those experiences, cherish them and ask questions and learn all the things. And here's my family, who I do it all for, our two Bernadoodles, Biscuit and Honey, and my husband, John, and our three kids, Gianna, Jadie, and Rosemary, so I appreciate your time. All right, good afternoon. It's nice to be on this presentation. Thanks, Tracy, for that great presentation. It's certainly good to see you and Prakash again. We all went to residency together, so it's very nice to reconnect and give this mini course, if you will. I wanted to just provide an overview of my talk, but first, let me tell you about myself. I founded the Private Practice Rehabilitation Physicians of Pittsburgh in 2014. It was straight out of residency. It didn't have any patient base. It was completely from scratch, so part of my talk today is going to be giving you some pearls and pitfalls, if you will, that I've gained over the past six years, and there is so much to talk about, but I'll try to condense everything into about 15 minutes, but I'm more than willing to talk with anyone afterwards. You can email me, if you would like. That would be great, but here's the outline for my talk. I kind of set it up as what I call different stones, and the reason why I did this, you know, when I was thinking about starting to practice out of residency without any resources, I almost perceived it as like a David and Goliath type of battle. That's how I structured it in my head, and if you know anything about the biblical story, David actually went into battle with five stones, and he was able to take down Goliath with just one stone, but a lot of people have speculated why David had five stones with him. Well, Goliath actually had four brothers, and David's thought was that if he defeated Goliath, he may have to take on Goliath's brothers, so that's why he had five stones. The point I'm trying to make with that is that Goliath was this mighty giant, and David was this very small, underpowered person, but he was prepared, and that's what led him to victory, so preparation is everything, and I hope I can help you get prepared if this is the next step in your venture. A little bit about myself. I come from two small business owners. My dad has been in business for 45 years. He had no formal business training. He had very humble beginnings. My mother, interestingly, has been in business for 50 years. She actually started cutting hair out of the basement of her house, and she's had a successful salon now for 50 years. So she's done very, very well and I take great pride in being her son. I'm the husband of an incredibly strong and supportive wife. I have three great children who you can see to the right of the slide who keep me young, I guess. And it's just a joy to have that support team around me and it's very important to have that. I'm the business partner of Dr. Berg, who is a physiatrist who has been just a great partner for the past six years. So it's really great to have him. I went to LECOM for medical school, also in Bradenton, Florida, and then I did my residency at UPMC, which was a great experience and gave me a diversity of experience that I've carried with me today. My only disclosure is that I own Rehabilitation Physicians of Pittsburgh, which we're talking about today. Okay, so how did this all start? So really, I can think back to high school when I was in graphic arts class and I was making business cards that said sports medicine physician on it. And I knew I always wanted to have a practice and be a physician, but really didn't get down to the nuts and bolts of it until 2006 when I started my first year of medical school. I remember sitting in the library and I came across a couple articles that really put things into perspective for me. So the first one was this medical economics series called Starting a Practice. And what it was is essentially a timeline and a checklist for individuals that wanted to start a practice. And it was incredibly helpful for me. So I actually used this as my roadmap and it is still available. I think you can find it online if you wanted to look that up, but it was incredibly helpful for me at a time when there weren't a lot of resources along the lines of starting a practice. So I had this game plan about how I was gonna do it, but I didn't really have any money or any other resources. So I came across another article by Dr. Gordon Moore, who's a family medicine physician. And Dr. Moore is credited with the idea of the ideal micro-practice model. So it's actually just basically showing you how to create a practice with low resources and basically using technology to leverage yourself and all about creating the best possible patient experience on a budget. So that's what I used to get started. And I found those articles to be incredibly helpful for me. But why would you go into private practice and pursue this? For me, part of what I was concerned about was burnout. And I was surprised to find out that this is a pretty significant problem in PM&R. And that's very contradictory to what I originally had thought about PM&R. I was surprised actually to find out about it because PM&R always seemed to be a very lifestyle conscious, special kind of thing. Lifestyle conscious specialty and physicians are usually engaging in exercise and taking care of themselves. And I just was surprised by it actually. But it's interesting to find out that a 2019 cross-sectional survey study, they looked at 1,536 board certified physiatrists and they use this mini Z burnout survey. I was surprised to find out that 770 physiatrists fulfilled the definition of burnout. So that was 50.7% of the cohort, which is really surprising. So the top three causes that they talk about for burnout, increased regulatory demands, workload and job demands, and then practice inefficiencies and lack of resources. So I started to think there's really not much I could do about regulatory demands, but perhaps I could work on practice efficiencies and work on my resources and that could help to reduce burnout. But burnout in general is defined as a loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment. So I wanted to kind of steer my ship in the right direction and prevent burnout. And that's why I said, I'm gonna go about this and try to do it on my own. So this is an incredibly cliche slide. So when you're thinking about starting a practice from scratch, you have to really think about what mindset you have, what characteristics do you have to have in order to make something like this work? So there's the characteristics of a competitor, right? So the classic underdog mentality, you're going into a fight, you have to think that you can win, okay? It's very important to always have that confidence in yourself. You also have to have focus, discipline, determination and perseverance. So these are all very important qualities if you're going to commit to starting a practice or any business venture for that matter. You didn't hear me say anything about an MBA. So do you need an MBA? No, I didn't have any MBA, no economics degree. I didn't really have any experience in negotiation tactics and I wasn't an Earl Elkins Award winner. And if nobody knows what that means, it actually was an award that was given by the board, that they stopped giving out in 2015. It was for the highest part one written board score. And I was not an Elkins Award winner, but I was still able to do this. So you don't need to be at the very top of your class to do that. A little bit about mental preparation. So there's interesting to look at the national trends. So if you look at that, there's a 50-50 split between employed and private practice positions. So right down the middle from a national standpoint. But locally here in Pittsburgh, where I practice, it's actually a 90-10 split employed versus private practice and that's because there's really two large health systems that are in this region. So there's really not a lot of private practice positions. We talked a little bit about burnout and being prepared for that. And trying to find ways to confront that. But why do you think residency graduates offer employed positions? Well, there's a lot of reasons why. There's benefits with salary and paid time off, vacation time, call coverage. All these things are great. And I can tell you that I don't really have any of those things. I don't have any vacation time or call coverage in a sense other than my partner, Dr. Berg. But these types of things are very attractive when you're graduating residency and you're looking at a job. But for me, it was more about this quest for happiness. I knew I wanted to do this. I wanted to stay true to my values. And so I decided to go towards it. And when I was constructing this venture, I was curious, like, really is big medicine Goliath? Am I David, this endangered medical entrepreneur? So I kind of thought about things almost from that perspective, but I actually was wrong. And I'll explain to you why a little bit later. Okay, so the next stone is really the methodology. So you've kind of mentally prepared and now you're gonna start to put this plan in action. When you're budgeting to start a practice, you really have a lot to think about. For me, there was a tremendous amount of medical school debt. And fortunately for me, I was on an income-based repayment program. So what that meant was that my loan repayment was capped at a certain percentage above my discretionary, or I'm sorry, a certain percentage of my discretionary income. So that meant if I was having a successful year, I would pay more towards my loans. If I wasn't having a successful week of a year, my payment would be lower. So that was really helpful for me to kind of have that sliding scale of payment from medical school loans. One thing that I really encourage a lot of people to do early is to start a nest egg. If you're interested in going into private practice and you can create a self-funded startup from the beginning, you'll be in a much better position than if you have to take out a lot of loans and dig it off the ground. So try to think about ways to cut your costs and tuck away some savings early on during residency. There's a lot of projected costs. Things like office space, furnishings, equipment, all different types of insurance that you'll need, just not malpractice insurance. There's other things like business insurance that you'll need, cybersecurity insurance. You could really spend a lot of money on those things. Your electronic medical record, your staff, all these things will cost money. And one of the tidbits that I learned early on was look at leasing options. Don't always think about purchasing equipment outright. What you'll find is that a lot of medical equipment depreciates, especially ultrasound. Every year there's newer units that are coming out that are capable of more and more bells and whistles. So think about leasing versus purchasing because those items depreciate and can cost you in the long run. Scale your costs appropriately. You may not wanna start off with the most expensive office furniture. You may wanna just kind of grow into things as you get more and more of a patient volume. Develop your niche. For me, it was developing a musculoskeletal practice with a high emphasis on the patient-doctor relationship. So one of the things that you may think is a perceived weakness, which is being a very small solo practice initially, could actually turn into one of your strengths by being able to leverage that customer service and that direct patient experience. So think about how you can turn perceived weaknesses into strengths. All right, next stone is the materialization, stone four. So here we talk about brand marketing on a budget. This was a critical lesson early on. I can think of a time when I spent $1,500 on a full-color, one-page magazine ad in a very popular magazine, and it yielded zero patients. And then later in the year, I spent about $125 on a black and white church bulletin, which was about an inch width with our logo in there. And I ended up getting about 10 or 15 patients from that. So spending more in marketing is not always the way to get more patients. You wanna think about free opportunities like social media platforms to get the word out about your practice. But word of mouth referrals is by far and large the greatest referral you can get. Create a great experience for your patient, and they'll tell family members, they'll tell friends about you, and you can start to grow your influence that way. I really emphasize the importance of developing relationships with all providers. So not just your colleagues in PM&R, but primary care physicians, physical therapists, occupational therapists. Don't forget about chiropractors and acupuncturists, massage therapists. These are all people that are practicing in your community that you can enhance your relationships with and develop a very good referral source. So think about that. I encourage everyone to think about maybe a side hustle or a side gig when you're first starting out in your practice. The funds are not gonna be coming through initially. So you wanna think about opportunities to make money, to create some financial stability for your family. For me, that was a medical directorship. That was some consultation work at a skilled nursing facility, and then also some medical legal work. So I was able to diversify my experience and create some financial security as we were getting started. But always stay true to your values and your vision. That's a really important thing. Zone five, the last thing we wanna talk about here is maneuvering. So you're constantly gonna have to negotiate if you're in private practice and you're the president or CEO of your business. You're always gonna have to be thinking about negotiation tactics. And I learned a lot from Chris Voss. He's a famous negotiator. And what he really talks about is avoiding battle. Like basically, negotiation shouldn't really be a battle. You should really be approaching it more as a dance. And if you can work with other parties to create a winning scenario for both parties, that's a very successful negotiation. So I try to go into negotiations not exclusively thinking about what our needs are, but what else we can do to help the person on the other side of the table. That's been very successful. You wanna make sure that you avoid closing doors in private practice. So listen to any and all opportunities that are presented to you. You really never know which opportunity is gonna lead to another opportunity. And I've been surprised time and time again when the very first proposal, the opportunity didn't seem like something I would be interested in, but then later led to even better opportunities. So avoid closing doors. Always play well with others. You are your own brand. I can't say that enough. You represent all the values of yourself and your practice with all your communications outside of your practice. And very importantly, don't be afraid to say no. You have to be protective of what you've built. And there will be times when others may try to compromise that. And you always have to be prepared to say no and to stay in control of what your vision is and the direction of your practice. So this is my last slide here. And really six years later, after starting this practice, I realized that Goliath was never big medicine. It was just a total misconception to think about it like that. What Goliath actually was, was this idea of the impossible, that it couldn't be done. You can't start a practice out of residency with zero patients. It can be done, okay? And I'm here to tell you that it can be done, but you have to be prepared and you have to be willing to put in the work to make it happen. And I'm very glad to talk to you guys. I look forward to taking any additional questions here at the end of our session. Thank you. Hi everyone. So I have the pleasure to be the last speaker today. I'm just gonna try and turn my camera so you can see me right there, right there. Perfect. So very great talks to begin this session. And please ask questions in the Q&A at the end of this session. I do not have any disclosures, but I'm gonna go a slightly different route with my talk to compare to the other two speakers, because I'm gonna be talking more about residency specifically and building a research career or an academic career, I should say, through your residency training. Our two speakers have done a great job of both providing some pearls of what they did in residency to take the next step in their careers. But I wanna give a little, on the academic side, I wanna give some things that worked well for me to sort of develop a clinician scientist career that I'm undertaking right now. So, as I said, I do not have any disclosures. The first thing that I want anyone who's in the audience right now to sort of do is to really think 50 years from now, depending on how old you are right now. But when you look back on your career, what is it you want to be known for? And it may be personal or professional goals. And where do you see yourself being in the long run? So it could be you wanna be a clinician, an educator, a scientist, a mixture of all three, a leader, it could be a leader in the academic realm, it could be a leader in the administrative realm. You could be an innovator, an entrepreneur. Do you wanna make lots of money? Is that how you would define your own success? Or would it be having a stable, happy family life? And is that how you would define your success? And I think it's a really good gut check every time that I've been in my career to date, in my career to date, to sort of think about where do I wanna be, it may not be 50 years from now, but 10 years from now, what would make me happy and what would make me happy with what I'm doing? And what would I define as my own success or others, and not let others define my own success? So who am I? So really sorry for the cheesy picture here, but I actually am from England. So this accent is not fake. I did my medical school training in King's College in London, and then I did a number of research internships in medical school. And initially, my father is an orthopedic surgeon, and he really influenced me and my career goals. And I loved musculoskeletal medicine. And in the UK at that time, the only way to really do musculoskeletal care was to do orthopedic surgery. So I was initially an orthopedic surgery resident at Oxford. And as I started my residency, I started to realize that my passion was not so much in, even though I had a big research background, my passion was not actually to be in the OR. My passion was to get to know my patients, develop rehabilitation programs for my patients, but also try and be a pioneer in some of the rehabilitation care that they were undertaking to prevent and negate the need for surgery. So in my third year of residency in the UK, my residency director allowed me to come to the US to continue doing research and do a PhD with a research mentor at the University of Missouri, who subsequently became one of the most important career mentors for me. But I came here to do the PhD and was due to go back. While I was doing my PhD at the University of Missouri, the chairman of the program, Dr. Greg Wershowitz, the PM&R program at Mizzou ended up, asked me, why do you want to do orthopedics? What is it about orthopedics or going back to that that makes you happy? And I realized, having talked to him, that it was a lot of it actually fit much better with a non-surgical specialty like PM&R, really getting to know my patients and developing treatment plans, as well as research opportunities in this area. So I ended up doing residency at UPMC, like my two colleagues. Went to fellowship at, at that time, RIC and Northwestern University, and I've stayed on as an attending physician scientist at Shirley Ryan Ability Lab. And I'm currently the director of clinical musculoskeletal research here as a clinician scientist. So the way I've split up my talk is really 10 pearls that I would say that have helped me develop my clinician scientist career. And I think some of these pearls of being productive in residency could be in whatever academic realm you see yourself going into in the future. It could be educational goals, it could be research goals, it could be administrative goals. So when I write this, it's really pertinent to me, which is, why do I want a clinician scientist career? But it could be, why do you see yourself being an administrator in an academic institution or being an educator in an academic institution? And as Dr. Falcone pointed out, what is it about teaching that you really enjoy? Or what is it about research that really engages you and gives you passion? So some of the things when I think about research specifically, and I think about when I speak to many of my residents about trying to get them involved in research, these are some of the reasons that I think people do research in residency. So trying to answer a clinical question, trying to improve the patient care, and then learning a new skill set, gaining knowledge and experience. And then, obviously, I'm a sports medicine trained physiatrist, and I did a fellowship in sports medicine. And many individuals choose to do research really for a numbers game, trying to develop research so that they have a more successful or better fellowship application, or make them more attractive for jobs in the future. I think one of the most important parts to do research is actually to develop mentor relationships. And both as a faculty mentor now, as well as as a resident, I would say that this was one of the most satisfying reasons to do research, was actually to develop a relationship with your faculty mentor, where you actually get to know what drives their clinical care, as well as what they're trying to do to improve clinical care. And I would say for me, that's been one of the best parts of being a faculty member at my institution. The other side is also to think about what are the negatives? What are some of the barriers to you actually engaging in an academic or a research career? And I would say, these are some of the things that I've heard from trainees in the past as to why they don't think that they should be doing research. So it could be they don't plan to do research after training, they're going to join a non-academic practice. Why does it matter? There's really no money in research. So why do I need to continue doing research? And then particularly those who want to go into more clinician-scientist careers, such as mine, I've often heard the term that, oh, well, I can leave it to my fourth year of residency to do research, and I don't have enough time for research right now. And I really don't know where to start. And that can be one of the most challenging issues at many institutions. Now, what I really did, which helped me during my residency training, was this. And this was actually pointed out to me from Dr. Berthold, who you just heard talk. And he really told me that every year in residency, and he was the year above me in residency and was one of my chief residents, he suggested, well, you need to have goals. What are your goals for each year of residency? And what I did was to try and map out a career plan. So I basically put together these sort of parts of my academic career. So each year of residency, I tried to hold myself accountable for this and then would reassess my five-year plan. So when we're thinking about these five domains, it could be academic research goals, clinical skill or procedural goals that I would want to gain by the end of that year, leadership or administrative goals, educational goals, or life goals of the location that I wanted to be. And that would obviously involve my family life. And see, these are some of the things that I incorporated as part of those goals. So we talked about academic goals, some of the conferences I would want to present at, when were the deadlines upcoming, workshops or lectures that I would want to give to the residency, clinical skill or procedural goals. I wanted to go into sports medicine fellowship. So trying to understand, trying to make sure I'd had enough repetitions with ultrasound, physical exam or patient evaluation goals, leadership or administrative goals. I joined in my second year, the FIT Council, at that time it was called something different, but I was a member of the FIT Council of the AAPMNR. And it was a great experience for me to actually meet many of the leaders in the field, as well as develop some of my administrative chops going forward. And then educational goals, and then life goals and location. This was a constant discussion with my wife about where we would want to be and what I would want to be doing in the future so that we had a happy, healthy family life and what she wanted to do with her own career, of course. And then ultimately where this would all lead five years from now was very, very important. The next step in thinking about how to be productive as residency was, and specifically now we're talking about research, was trying to understand, identify clinical question or domain that I was particularly passionate about. And this could be saying, if you're interested in medical education, what is it about in a specific domain that you are very passionate about, and how could you develop your interest or passion for that domain? And as has been talked about, particularly with Dr. Falcone's talk, you know, I was very fortunate in every step of my career to have phenomenal mentors. So in my medical school training, as well as my PhD training, my mentor at the University of Missouri, who was my scientific mentor, Dr. Werschwitz, who was, as I said, was my was my mentor as I joined my PhD and as I transitioned to residency and continues to be a big mentor in my career overall. And then Dr. Sowa was my scientific mentor in my particular scientific domain, which was very, very, very, very important for me as well. And then Dr. Press, who was my fellowship mentor, really helped me sort of solidify, put everything together and think about how am I going to take the next step of my career as I transition into an academic position. Now it's important to think about mentors and mentors provide a lot during residency and not all of them are hugely funded, but they may provide you, a lot of them give you so much of their time. It's really amazing. And I was been very fortunate to have that. So when we think about it on the scientific realm, they can provide you expertise and this could be, this could be educational expertise or scientific expertise, depending on your interest, resources, cultural guidance. So this could be guidance within the institution that you're potentially going to apply to or potentially stay at, advocate for you. So if you're applying for a job at a particular institution and you have a mentor at that institution, that's extremely helpful. A good mentor will provide you feedback on your strengths and weaknesses. A mentor doesn't just give you, tell you how great you are all the time, they'll also tell you constructively how to actually improve your career and how to take it forward. And then also training sometimes on the particular scientific domain or educational domain that you want to move with your career forward into. So when I'm thinking about my own career, I sort of, and particularly from the research realm, first thing to remember when you're thinking about residency is the scholarly expectations of your residency. What is the timeline for that? And then as a PGY2 or PGY3, particularly on the research realm, and this could be certainly for the educational realm too, there's a lot of low hanging fruit within your residency program. So this could be case reports, presenting them at national meetings, performing QI projects or retrospective chart reviews and all, whatever hospital you are at, there are opportunities to do retrospective chart reviews. And you don't need a really expert mentor in that, in doing retrospective chart reviews to be able to do that. So it's important to think about these sort of low hanging fruit opportunities that really help solidify your career as you go forward into faculty positions. The next is to be opportunistic. So I had a project when I was at UPMC, where they had a QI funding. So this was a, I'm not a stroke researcher currently, I'm a musculoskeletal researcher. But at the time when I was on my inpatient rounds, I was always frustrated about patients losing motivation to actually continue their rehab programs. And so what I was interested in is, well, if we provide them video feedback of their rehab progress, does that actually improve motivation of our stroke patients? And I managed to get some funding, some small funding from our institution to look at this and it was a successful study going forward. So something simple like that, where you notice something that could be improved and there's, most institutions are looking for ways to improve or expedite the care of their patients. That's something else to consider as well. The next part, which is really then, if you're particularly for a research career, is then focusing in your interests. So rather than, is really looking at the minutiae of your discipline, rather than a broad skillset. And so I joined the RMSTP program at the AAP, which is run by Dr. Boninger and Dr. White. And it was a great program for me to actually develop my scientific domain going forward, as well as learning from other experts in the field, particularly who are clinician scientists. And then I developed a much more specific project in knee osteoarthritis, and it was a project to look at continuous walking regimens versus interval walking regimens and impact on the biomarker profile in these individuals. Now, I'm not going to go into the science so much, but just to say that this specific project really helped me springboard into the next phase of my career, because I was able to go on interviews and explain my research and actually give some credence to the fact that I was saying that I'm going to be a clinician scientist in this domain. So having credence is really, really important when you're trying to say that there's a niche of a career that you want to have in the future, particularly in academics. The next phase, which I think is really important when we think about academic careers, is being selective of your opportunities. When you start out, it's really easy to say yes to everything. But nowadays, I look back and I think about opportunities that I took on that I probably should have said no to. And I think this is what I take forward, particularly in those starting out their careers, is when any opportunity gets given, you want to think about, does it help my ultimate goal? Do I have the time to dedicate to it? And what are the expectations and timeline of my mentor or faculty member who I'm working with on this? And will I receive oversight and guidance? And then the next phase, which I didn't do when I was a resident, which I wish I had done, is that once you take it on, reassess that time that you've actually dedicated to this, and as well as those that you dedicate to all of your other activities. Finally, as a clinician scientist, I sort of started to think about the skill set that I need. So I am a biologist, really, in terms of my research, and I put together a K Award, which is a training award for clinician scientists, Mentored Career Development Award. And I realized I needed expertise on clinical trial development, as well as biomechanical evaluation. So I spent time during my fellowship year to try and get some of those skill sets so that I could take the next step in my career and feel that I was ready for that. The big thing to do is to then finally say, my 10th and most important goal is to avoid the pitfall. So saying yes to everything is not good, but saying no to everything can also not good either. Faking interest in something, often, I can tell that now as an early career scientist is that when I see a trainee who's faking interest in something, it's pretty obvious to me. And it's not any slight on them. They feel bad telling me that it's not something that they are passionate about. But it is important to think most projects that get really far, whether they're medical education or research, are dependent on the passion that a resident or a trainee has for them. So that's really important to think about. Not asking for help, believing that you're the only one confused, having poor insight that a specific mentor or mentee relationship is working or not working, losing perspective. And then the last two part is forgetting your hobbies and neglecting your personal life. And I think I certainly wouldn't be here without my wife and my kids. And I think it's very important to understand and negotiate that relationship with your family of everyone's goals, particularly your spouse's goals, but also thinking about how that plays into the future career that you want, as well as the future family life that you want collectively. And with that, please feel free to reach out to me if you have any questions through email. But now I'm going to ask us to come back together as a group for the last six minutes for some questions. And I think we do have some questions to the panel. So thank you so much for everyone. So I'm going to dive right into the questions. So Dr. Berthold, we have a question for you is, so I'm coming to a great lecture, attorney sometimes asked to work with a practicing physiatrist for IME purposes. How should one handle it while setting up his practice right out of residency? Okay, thanks, that's a good question. That opportunity wasn't really available to me when I was first coming out of residency. And when we first started the practice up, it actually took some time to develop a practice and kind of establish a name in the community before we started to get approached with that type of work. Really, you know, when I was talking about some of the ways to diversify your income initially, some of the most obvious things that were readily available were consulting work. There were plenty of opportunities in skilled nursing facilities to serve as a physical medicine rehab consultant. And also there were some opportunities for directorships that came up early on, which were helpful. But yeah, for medical legal work, I think that really depends on your experience level and those opportunities kind of will present themselves in time with the question. Thank you. Thanks for that answer. The next question is probably for all three of us, but I think probably for Dr. Falcone the most. Dr. Falcone, do you think the transition from residency to practice could be helped by providing non-clinical skills such as leadership training, coding, billing, etc. while in residency? Absolutely. And I think also just documentation standards that need to be included for both, because we have professional coders and builders or billers. So they're only going to have a certain subset of keywords or key diagnoses that they know to pick up on, like they're not going to see heart failure. They're going to need to know, is it systolic or diastolic heart failure? Are we in a chronic phase or are we in acute phase? Do you have speech online because they have cognitive impairments, etc. So the more that you can hone in on, number one, how to document so your coders can pick up appropriately. Two, how to document so that you're meeting all the systems requirements to upcode as much as possible, because we know we spend a lot of time with our patients. We deserve payment for the time that we spend. So discussing things like that, and then of course discussing administrative aspects and actually what we're worth as administrators, because I know that's on social media, there's a lot of discussions about, I'm a medical director, how much income are you getting? I think as a residency, we need to discuss some of those things with residents as well so that we know what we bring to the table and what to ask for. The next question I have is to you, Dr. Falcone, again. So just really asking about, you talked about your husband being a general surgeon. How did you negotiate your career, your relationship with your careers in trying to decide time management and those things, or how did that work? Honestly, initially, because the career path for physiatry, I think, is a little bit more variable than general surgery, I went ahead and let him take the lead. He's obviously going to have to be on 24-7 trauma call multiple times per month. I always describe our complementary fields as he's life-saving, I'm quality of life-saving, so quality of life can wait. We really prioritized his needs in regards to who's on call and time spent. So if he's on call, then I'm going to try to set my day as a lighter day so I can take over family needs and things like that. That's great. Then I think we have a minute remaining, so Dr. Berthold, this one's for you. In terms of setting expectations for yourself and you think about your practice, in academic practice it's easy. We have goals from the institution of what we should achieve, our views that we should attain. How did you set up expectations for your own practice as you started out your practice? That's a great question, too. So initially when I was starting out, my goal was just to survive the first year. I wasn't really projecting far out beyond that because that was a really tough year. You're just getting out of residency, you're getting credentialed with insurance plans, and you may not be getting paid for a while. So that was my first checkpoint, was the first year. I knew that whenever the very first week in practice I had seven patients. I remember calling the answering machine at the residency graduation dinner to see how many people were going to be coming in the next week, and I had seven. But each year we kind of track our markers and we see how the practice is growing and expanding, and now it's grown quite a bit over the past six years. So I think you just want to keep good metrics in your practice as to the volumes of patients that you're seeing, how many new patient referrals you're getting, and just make sure that that trend is always going in the upward direction. That's great. I'm just kidding. Okay. We've been given clearance. We're slightly over time, but we've been given clearance to answer one more question. Thanks, Tiffany. So this is from Tomas. What are some go-to places to rent equipment from, ultrasound, EMG, et cetera? Or maybe you can speak to that, Berthold, how did your equipment purchases, things like that, how did you make that happen? And then rentals, I think also would help as well with this question. Yeah. So early on, I made some mistakes by purchasing equipment. And like I mentioned in the talk, medical equipment can become obsolete very quickly and outdated, and the technology is rapidly changing. So you never want to find yourself in a position where you're stuck with a piece of medical equipment that has no resale value. So I really recommend looking at leasing options, especially when you're just getting started because it kind of gives you the flexibility at that point to return the equipment if things aren't going in the direction that you want it to. But there are also companies now, different ultrasound vendors that allow you to work on shorter contracts and rental terms for an annual basis. One thing I would point out is that when you're looking at these agreements, everything is negotiable. And like I talked about in the presentation, they want your business just as much as you want their product. So try to work with these companies when you're starting out to make sure that the terms and agreements are comfortable by you and that you're not setting yourself up to be in a position where you're in a hole and having to dig yourself out. But there are plenty of opportunities for leasing, short-term leasing options and rental agreements. OK, thank you so much. I think we're out of time. We went slightly over. We really appreciate the questions in the chat. there was really great questions and I really want to thank my esteemed panel for their great talks today and I wish you guys all the best. Please everyone stay safe and healthy and hopefully we'll see you all in person next year. Thanks so much. Thank you.

faculty members

career development strategies

residency to practice

challenges faced

strategies to overcome challenges

career goals

mentorship

diversifying skills

balancing goals

self-reflection